Date: 04/05/2011

Author: Tebogo Monama and Siphiliselwe Makhanya (Sowetan Live)

AFTER seven years of living with a buffalo hump - a growth at the back of the neck - Nthabiseng Mokoena will finally have it removed this week.

Mokoena, 40, from Motsoaledi informal settlement in Soweto, is one of 17 HIV-Aids patients at the Chris Hani Baragwanath Academic Hospital who will have corrective surgery as part of Lipodystrophy Week. According to Dr Gabriel Doucas, lipodystrophy is the "rearrangement of fat from places it should be to places it should not be."

The condition is a side effect of certain anti-retroviral (ARVs) cocktails. Patients have to change their cocktail of pills to stop developing further side effects. Doucas said: "The condition is caused by a reaction to ARVs. "It is a minor side-effect of the pills but it is major to us because it makes the 'deformity' in patients obvious and they then want to stop taking their ARVs.

"Some people get tummy fat on the inside and outside. The fat from the bum moves to the stomach. "This is dangerous in that it affects metabolism which can lead to diabetes and high cholesterol. "Some guys grow female breasts, while other people develop gaunt faces. "Some women grow very large breasts that cause back problems and infections under the breasts."

Mokoena said: "This thing started growing in 2004 and has made living a normal life very difficult. I cannot wear certain things and it gets very painful sometimes. "I am happy that doctors changed my cocktail of pills. Even though they do not know what causes it, people make fun of me. "The doctor is a really good person and I would like to thank him and the hospital in advance for helping me lead a normal life again."

Doucas said corrective surgery for lipodystrophy is carried out twice a year. The campaign started in 2009. "We hope that this project grows. The initiative is not formal because we do not have enough funds. The hospital just puts in all its resources into the surgeries. It is first come, first served. "The problem with this surgery is that its elective. We rarely get a chance to do corrective surgery because cases are often cancelled or postponed as they are not an emergency," he said.

"The danger with this is that patients stop taking their medication because their communities can see their side effects. "Patients should not stop taking their ARVs because that's what changes HIV from a terminal to a chronic disease that can be managed. "During this week, if a patient has two side effects we can only treat one. The patient chooses to address a problem that affects them most of the time.

"The other problem is that the surgery is expensive. Patients pay between R30,000 and R35,000 but this week we will do it for free. "Male patients are the most appreciative because they have no way of hiding their breasts. " Since 2009, we have had a lot of happy patients. Literally all have healed well." Doucas said they can only operate on patients who are stable on treatment that does not cause lipodystrophy for six months.

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